Background: New antidepressants emerged and
became widely used during the 1990s. The present study
investigated quality-of-care problems in the treatment of
depression in a current psychiatric setting.

Method: We investigated the treatment received
for depression by all 803 inpatients or outpatients with a
clinical diagnosis of ICD-10 depressive episode or recurrent
depressive disorder in 1996 in the Peijas Medical Care District,
which provides psychiatric services for citizens of Vantaa, a
city in southern Finland.

Results: Most patients (84%) in the sample were
found to have received antidepressants, generally in adequate,
albeit low, doses. Inadequate antidepressant treatment was common
only with tricyclic antidepressants. Most patients received a
single antidepressant for extended periods; only 22% had 2 or
more antidepressant trials. During the treatment period,
disability pension was granted to 19% of those not already
pensioned, two thirds (67%) of whom had received only 1
antidepressant trial prior to being granted a pension.

Conclusion: The present study supports the
emerging perception of improved quality of pharmacotherapy in
psychiatric settings, with the exception of treatment with
tricyclic antidepressants. Problems of quality of care now appear
to be related to the suboptimal intensity and monitoring of the
treatment provided, which may eventually result in considerable
costs to society due to permanent disability.